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The 411 on Medicare

October 12, 2017

Enrolling in Medicare can be a daunting task.

Enter Vickie Carraher, Ohio Senior Health Insurance Information Programs (OSHIIP) volunteer counselor and senior service coordinator at the City of Kettering. She recently led a Medicare seminar, sponsored by Kettering Health Network, describing in detail the ins and outs of enrollment for one of the most confusing, yet important, programs in the country.

You have two options for receiving Medicare benefits: either through original Medicare (Part A and Part B) or through a Medicare Advantage Plan (Part C). Different parts of Medicare cover specific services:

*Tip: Carraher explained that, if you find yourself at the hospital emergency room, always ask the question, “Are you admitting me or keeping me for observation?” because your Medicare Part A benefits do not apply if you are not admitted. Think about the “A” in Part A standing for “admission.”

Part C (Medicare Advantage Plans): plans offered by private companies that contract with Medicare to provide your Part A and Part B benefits and, most often, Part D. Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans, and Medicare Medical Savings Account Plans. These plans often provide additional benefits, such as coverage for vision, hearing, and dental, though you may have to use plan-specific doctors and hospitals. You must be enrolled in Medicare Part A and Part B in order to enroll in a Medicare Advantage Plan.

Part D: is for prescription drug coverage. These plans are offered by insurance companies and other private companies approved by Medicare.

*Tip: Everyone is required to sign up for Part D, or you will be charged a penalty of 1% of the national base beneficiary premium ($35.63 in 2017), multiplied by the number of full, uncovered months you didn't have Part D or creditable coverage. For example, if you weren’t covered for three months this year, you would be charged a penalty of $106.89.

Applying for Medicare

Initial enrollment for Parts A and B is at age 65. You can apply three months before, the month of, and three months after your 65th birthday. If you fail to sign up for Part B during the initial enrollment period, you will be charged a late enrollment penalty.

If you didn’t sign up for Parts A and B during your initial enrollment period, you can sign up during the general enrollment period between January 1-March 31 every year.

Open enrollment is for those aged 65 and older, or disabled under Social Security Disability for two years, who want to enroll in or change their Medicare Advantage or Medicare D prescription plans. Medicare open enrollment for 2018 coverage runs from Oct. 15, 2017, to Dec. 7, 2017.

You do not need to retire to receive Medicare. However, if you do not retire and are keeping your employer-sponsored insurance, you may not need Medicare Parts A and B and/or D.

You are automatically enrolled if you are receiving Social Security or Railroad Retirement Benefits before age 65